De Quervain tenosynovitis

Background

• Tenosynovitis of abductor pollicis, extensor pollicis brevis
  • Groove of radial styloid
  • First extensor compartment
• 30-50 yoa, more common in women
• Overuse of the thumb
  • Classically mothers that frequently lift infants
  • Or secretarial, nursing occupations
  • Or even texting

Clinical Features

• Pain along radial aspect of wrist (may radiate to thumb or extend into the forearm)
• Painful abduction of thumb
• Decreased grip strength
• Swelling at tendon sheath along radial styloid
• Positive Finkelstein, pathognomonic
  • Pt grasps thumb in palm of the hand and ulnar deviates the thumb and hand
  • Stretches the tendons over the radial styloid producing sharp pain
• Negative Phalen and Tinel test

Differential Diagnosis

Hand and finger injuries

• Distal finger
  • Finger amputation
  • Fingertip laceration
  • Nail avulsion
  • Nailbed laceration
  • Subungual hematoma
• Other finger/thumb
  • Boutonniere deformity
  • Mallet finger
    • Swan neck deformity
  • Jammed finger
  • Jersey finger
  • Trigger finger
  • Ring avulsion injury
  • De Quervain tenosynovitis
  • Infiltrative tenosynovitis
  • Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
• Hand
  • Dupuytren contracture
• Wrist
  • Drummer's wrist
  • Ganglion cyst
  • Lunotriquetral ligament instability
  • Scaphoid fracture
  • Extensor digitorum tenosynovitis
  • Compressive neuropathy ("bracelet syndrome")
  • Intersection syndrome
  • Snapping Extensor Carpi Ulnaris
  • Vaughn Jackson syndrome
• General
  • Hand and finger dislocations
  • Hand and finger fractures
  • Hand and finger infections
  • Gout and pseudogout
  • Hand and finger tendon injuries
  • High-pressure injection injury
  • Osteoarthritis
  • Rheumatoid arthritis
  • Ring removal

Treatment

• Splint thumb and wrist
  • Instruct pt to remove splint briefly each day to perform range-of-motion exercises
• NSAIDs x 10-14d
• Persistent cases may require steroid injection or surgical decompression

See Also

• Radiograph-Negative Hand and Finger Injuries

References

• Diop AN, Ba-Diop S, Sane JC et-al. [Role of US in the management of de Quervain's tenosynovitis: review of 22 cases] J Radiol. 2008;89 (9 Pt 1): 1081-4.
• Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. 2007;31 (2): 265-8.